Provider Demographics
NPI:1497828420
Name:RENFROW, KENNETH JAMES (MS, LPCC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:JAMES
Last Name:RENFROW
Suffix:
Gender:M
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BLUE LINE DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2325
Mailing Address - Country:US
Mailing Address - Phone:740-592-5689
Mailing Address - Fax:740-593-7166
Practice Address - Street 1:17 BLUE LINE DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2325
Practice Address - Country:US
Practice Address - Phone:740-592-5689
Practice Address - Fax:740-593-7166
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-3610101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional